Starting Feminizing Hormone Therapy: What to Know

For many transgender women, starting feminizing hormone therapy is a significant milestone in their lives. Not only does it help change their appearance to align with their true gender identity, but it is also part of the journey of self-acceptance and living authentically. However, feminizing hormone therapy should not be undertaken lightly or based on unsafe information. Before making a decision, it is important to fully understand the benefits, risks, and possible side effects.

What is feminizing hormone therapy for transgender women?

Feminizing Hormone Therapy (FHT) involves the use of female sex hormones and/or anti-androgen medications to help the body change in a more feminine direction, such as: breast development, a less deep voice, smoother skin, and changes in body shape.

Feminizing hormone therapy typically includes two main groups:

• Estrogen group (Estrogen) such as estradiol valerate, estradiol hemihydrate, or estradiol patches, which help enhance feminine characteristics
• Anti-androgen group (Anti-androgens) such as spironolactone, cyproterone acetate, which help reduce male sex hormone levels and support estrogen effectiveness

Why is it important to consult a doctor before starting feminizing hormone therapy?

Although it may be easy to purchase hormones from various sources, safely starting the therapy requires:

• Health evaluation and risk assessment such as cardiovascular disease, hypertension, kidney or liver disease
• Planning hormone use that is suitable for age, weight, health status, and personal goals
• Regular blood tests to adjust dosage balance

Using hormones without a doctor's prescription can lead to complications such as blood clots, hypertension, or liver inflammation.

Health evaluation before starting hormone therapy: what needs to be checked?

Before starting feminizing hormone therapy, doctors usually prescribe:

• Blood tests: measuring estrogen, testosterone, kidney, liver, lipid, and blood sugar levels
• General health examination: pulse, blood pressure, BMI, and medical history
• Psychological evaluation (in some cases): screening for depression or other conditions that may affect treatment decisions

If there are pre-existing conditions, the doctor will assess the risks and adjust the hormone regimen accordingly.

Different forms of hormones: oral, injection, patch, and their differences

Hormones come in various forms, each with its own advantages and disadvantages:

• Oral form (e.g., estradiol 2 mg)
  Advantages: convenient, low cost
  Disadvantages: metabolized by the liver, may increase the risk of liver inflammation or blood clots
• Injection form (e.g., estradiol valerate intramuscular injection)
  Advantages: rapid absorption, not through the liver
  Disadvantages: higher cost, requires medical personnel for administration
• Patch/gel form (e.g., estradiol patch)
  Advantages: absorbed through the skin, not through the liver
  Disadvantages: higher cost, needs frequent replacement

Expected results

The effects of hormones vary from person to person. Common changes within the first 3–12 months include:

• Breast development (3–6 months)
• Reduced body hair
• Reduced muscle mass, redistributed fat
• Smoother skin
• Reduced sexual desire
• Increased emotional sensitivity

However, voice pitch will not change, and facial hair often requires laser hair removal.

Potential side effects to be aware of

Although widely used, feminizing hormone therapy still has potential side effects:

• Increased blood pressure
• Blood clots (especially in smokers)
• Headaches or migraines
• Hormone-induced liver inflammation
• Depression or emotional disorders

If unusual symptoms appear, stop the medication immediately and consult a doctor.

Hormones and mental health: changes in both body and mind

Many transgender women report that hormones help them feel more like themselves, happier, and reduce gender-related stress.

However, some people may experience emotional fluctuations or depression during the transition phase. Therefore, mental health care alongside hormone therapy is essential. It is advisable to have a counselor or support group to share experiences and receive encouragement.

How to know if feminizing hormone therapy is effective?

Regular blood tests every 3–6 months are recommended to evaluate:

• Estrogen levels within the appropriate range (100–200 pg/mL)
• Testosterone levels reduced to female physiological levels (<50 ng/dL)
• Lipid, blood sugar, liver, and kidney function remain safe

In addition, physical changes such as improved breast size or skin quality are also signs that the hormones are working.

Frequently asked questions about feminizing hormone therapy

Q: Does hormone use cause infertility?

A: Yes. Feminizing hormones reduce sperm count, which may cause temporary or permanent infertility. If you still wish to have children in the future, consider sperm banking before treatment.

Q: If hormone use is stopped, will the body return to a male state?

A: Some changes such as muscle mass and body hair may recover. Breasts remain but may slightly decrease in size.

Q: Can hormones be purchased without visiting a medical facility?

A: It is possible, but not recommended due to high risks. The quality of the medication cannot be guaranteed, and there is a risk of serious long-term health complications.

Hormones are not a miracle, but a journey that requires careful self-care. Feminizing hormone therapy for transgender women is a deep process, both physically and mentally. Not everyone needs the same changes, and not everyone needs hormones to become a transgender woman. Gender identity is not just about medication or the body, but also about self-acceptance and the path you choose.

References:

• Starting hormone use for transgender individuals: https://thaisisterhood.com/article/starting-hormones
• Hormone therapy in gender-affirming care: https://www.bumrungrad.com/th/health-blog/may-2022/gender-affirming-hormone-therapy
• Use and safety of hormones in physiological changes for transgender women:
  https://ccpe.pharmacycouncil.org/index.php?option=article_detail&subpage=article_detail&id=1248